The case for and against vaginal examination in labour

[verylittlecarrot]

I'm considering declining VEs in labour, as it seems to me that the information they provide (2cm? 5cm?) is of no benefit to ME as the labouring mother. In fact, last time they were extremely demoralising and pretty much precipitated a big meltdown to be told I wasn't progressing, where previously I'd been coping quite well. My MW has only really managed to articulate the benefit to her, as in, "I'll know whether you're really in labour or not" (aka as I can justify buggering off for a while).

From what I've read, the 'purple line' is quite a good indication of dilatation, and there are various other signs of progression of labour.

Besides, what can one DO with the info? 2cm to 10 cm can take 2 hours in one woman, but 3 days in another, so how can any meaningful decisions be reached on that basis alone?

The only thing that concerns me is the whole 'pushing too early' scenario, when there may still be a cervical lip. (check out the MN official useful info on this topic!) Does this happen often? Are our bodies so badly designed that we feel the natural urge to push before it is safe, and need to resist our own instincts? My common sense questions this idea that women need some external third party to tell them when they can and can't push, and give them permission. I'd have thought that evolution kinda took care of that instinct properly.

But I'm open-minded, and want to hear the case for and against VEs. Do you reckon they are yet another intervention that, actually, are rather unnecessary, or do they provide vital info that we can't do without?

did i know you were pg?? congratulations, when are you due?

with DS i got an urge to push when i must have been about 8cm, although i resisted it until we got to hospital.

with dd i was examined and was told i was 9 1/2 cm, i.e. this cervical lip thing. Had no urge to push until it had cleared.

So i suppose what i'm saying is IME you can trust your body. What did you find last time?

That said, I found pushing incredibly hard work - my body didn't do much work then, it was all me

I would have appreciated a VE earlier in my labour, like the other poster who wasn't 'obviously' in labour, when they found DH and I loading up a DVD to watch I got a 'Well, we'd better look at how you're doing then I suppose' in an 'I think you're wasting our time here' tone. I was 7cm which meant no meaningful pain relief for what turned into a very protracted pushing stage.

Just another data point for you, VLC: I had a cervical lip with my first (turned out it was mostly due to DS1 presenting with his head slightly skew). I had an urge to push from probably around 9cm and yes, it would have done some damage if I'd followed up on it.

VEs can be demoralising - but slow labours tend to have that effect anyway, whatever technique you use to monitor them. On the other hand they can also be quite motivating, when you find things are progressing. I didn't have any with DS2 (home birth, quite quick) the midwife didn't think it was necessary despite a history of incomplete dilation.

I, too, found VEs very demoralising during my first labour. Very painful, too. For subsequent labours I insisted on minimising the number of VEs, and my requests were respected.

With no2 I had only one VE, when I needed to push. I allowed that one because 1) After my demoralising experience with my first labour, I lacked confidence in my own body and was happy to have my insitncts confirmed by the midwife; and 2) I liked and trusted that particular midwife, and knew from experience that she had small gentle hands.

She wanted to do the VE because, despite being in the labour ward for 2h, I had not been observed by any midwives, only briefly monitored when I first arrived.

With no3 I did not have any VEs at all, until the mw checked me for damage after the birth.

I think that, if you are allowed to be mobile and relaxed, then VEs are probably less important than if you are on a bed or not able to move around much. If you are upright and mobile, your body does much of the work on its own. I didn't even push my last dc out - just let my body and gravity do the job. Also, if you labour with an experienced midwife observing you, she will get a feel for how your labour is progressing, and be able to assess your situation without actually feeling you.

I arrived at the hospital expecting to be examined with ds3 just to get a feel for what was going on (no contractions just crippling bone pain) and MW said no, you're in labour (!) and we don't do VEs unless there is a medical reason. She did one when I asked for morphine (but then said I was too far gone). They seem to have a very hands off approach here which works (at least for me).

My lovely birth centre midwife started giving me a VE on arrival, but apparently I was squirming around too much (don't remember this bit but DP does) and clearly well on the way, so she didn't persist and let me jump into the pool. DS arrived a couple of hours later with no more VEs, I was kneeling forwards most of the time so I guess she could see that purple line too. I hadn't especially asked for no VEs, but I suppose it goes with the territory with a waterbirth.
I think I wouldn't refuse one in a future birth though, if the person attending me felt there was a good clinical reason for it.